Intra-operative phlebography in the varicocele.
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Biomedical subjects
Publications and source records attributed to A Manenti.
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Multiple stones in the cystic duct often cause obstructive jaundice by external compression of the common bile duct (a stone blocked in the cysticochpledocal junction, or adhesions between the two biliary ducts). Intraoperative cholangiography and careful dissection usually lead to sure diagnosis and easy recovery.
Two cases of malformative dilatations of biliary ducts are described. Besides the pathogenesis, the authors illustrate the classing, clinics and instrumental diagnostic of such malformation, and conclude with a wide survey of the changes of surgical correction.
Neighboring tumors can extend to the hepatic pedicle, usually through lymphatic involvement. Four such cases are reported. Thrombosis of the portal vein may develop. Cholestatic jaundice is the main clinical feature. Prehepatic portal hypertension may be present. Hepatojejunostomy is often the only possible surgical procedure.
The superior mesenteric artery and vein can easily be approached through a subduodenal left retroperitoneal route and dissected. The procedure proved extremely useful in right hemicolectomy, cephalic duodeno-pancreatectomy, mesentero-caval anastomosis and direct interventions on the superior mesenteric artery.
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The authors describe a new technique aimed at restoring continuity of the digestive tract after total gastrectomy by means of a jejunal loop anastomosed with the oesophagus and the duodenum. A new stomach-like reservoir is formed in the process, with two outlets (peristaltic and antiperistaltic) preventing oesophageal reflux and stenosis in case of recurrent coeliac tumour.
During mastectomy using the Madden technique full dissection of the axillary and supraclavicular lymph nodes can readily be achieved by the anterior approach, after transverse separation of the upper fibers of the pectoralis major.
In subtotal gastrectomy for carcinoma the key to radical dissection of the lesser curvature is mobilisation of the hepatic artery up to the coeliaque axis, where the left gastric artery can be divided at its point of origin. Blood supply to the gastric stump is ensured by the short gastric vessels, the posterior oesophago-gastric artery and the intraparietal anastomoses between oesophageal and gastric vessels.
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Transhepatic drainage has been extended to all hepaticojejunal anastomoses. This simple technique consists of intubation of the jejunum anastomosed to the hepatic duct by a drain guided in a retrograde direction in the common hepatic duct and the intrahepatic biliary tree, and emerging through the convex surface of the liver.
Vascularization of the first 60 cm of the jejunum is considered on the basis of a necroptic study of 100 cases. Attention is called to the possibility that surgical failure in ansa transposition techniques may be due to anatomical variations in the first jejunal branches of the superior mesenteric.
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Experience with laparoscopy in 1,720 cases performed for surgical diseases with elective or emergency indications is reported. It is hoped that laparoscopy, a simple and harmless technic of great diagnostic value, will be employed more frequently in routine and emergency surgery.
After a brief review of thermal physics and physiology, the authors explain the applications of cholesterol ester plates in the study of breast malignancy. Accumulated experience plus the fruits of statistical studies conducted in leading centers, make it advantageous to use contact thermography not only for the early diagnosis of breast malignancy but also for mass screening of the general population. In competent hands, this technic yields accurate and dependable diagnosis; the method is completely harmless to patient and physician and can be used as many times as needed; and in addition, the method is economical both in terms of time consumed and of actual cost of materials. The new method does not supersede roentgenological investigation indiscriminately but confines it to cases that remain doubtful or suspicious after clinical and thermographic examination.
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